The Takeaway Cushing’s syndrome is a rare health condition that can occur when your body experiences prolonged exposure to a high cortisol level. Common symptoms include unintended weight gain, a rounded face, thinning limbs, and muscle weakness. You can develop Cushing’s syndrome due to frequent use of glucocorticoid medications or if you have a tumor on your pituitary or adrenal glands. If you have a diagnosis of Cushing’s syndrome, your healthcare provider may recommend a low-dose glucocorticoid alternative, surgery, medication, and radiation.
Symptoms Signs and Symptoms of Cushing’s Syndrome The signs and symptoms of Cushing’s syndrome can vary from person to person. Even with the most common symptoms of the condition, “not all patients have all of them,” says Maria Fleseriu, MD , professor of medicine and neurological surgery and director of the Pituitary Center at Oregon Health and Science University in Portland, Oregon. If you live with Cushing’s syndrome, you may experience the following symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e597629679484cc-b6e8-48e6-8652-0d28c5d08c6b Unintended weight gain Round face Increased fat on the base of the neck Buffalo hump between the shoulders Thin arms and legs Muscle weakness Easy bruising Purple stretch marks on the abdomen, breasts, or hips Acne Symptoms can vary by sex. Women with Cushing’s syndrome are likely to experience irregular menstrual periods and extra facial or body hair. While men are less likely to live with Cushing’s syndrome, those who do have a diagnosis may notice a lowered sex drive, erectile dysfunction, and fertility changes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e0c701fd-80ea-490b-bd27-69f3278ac79a According to Dr. Fleseriu, other less common symptoms are also possible: Sleep disruption Extreme fatigue Trouble regulating emotions Depression or anxiety Difficulty thinking High blood pressure Headaches Bone loss A small number of people experience what’s known as cyclic Cushing’s syndrome, meaning the symptoms come and go as your body’s cortisol level becomes elevated and then returns to normal.e60dc2a1-f33c-4a05-9b50-8e3e8e59762979b037a8-ff45-4eac-9df3-0d970b845bc1
Resources We Trust National Institute of Diabetes and Digestive and Kidney Diseases: Cushing’s SyndromeEndocrine Society: Cushing’s Syndrome and Cushing DiseaseMayo Clinic: Cushing SyndromeCleveland Clinic: Cushing SyndromeCushing’s Support and Research Foundation: Homepage
Causes What Causes Cushing’s Syndrome? Generally, there are two categories of what causes Cushing’s syndrome: exogenous (outside your body) and endogenous (inside your body). Exogenous Cushing’s syndrome occurs when you take steroid medications called glucocorticoids , which healthcare providers often prescribe to help reduce inflammation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629460114db-b893-42b5-ac19-8263e0ea94b7 Any form of glucocorticoid drug, whether it’s an injection, topical cream, or pill, may lead to Cushing’s syndrome over time, especially if the doses are large enough.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b1c074e-a9c3-4e8a-885b-2d25ee426ca7 On the other hand, endogenous Cushing’s syndrome may occur when something causes your body to make too much cortisol on its own. Normally, your pituitary gland at the base of your brain releases a hormone called adrenocorticotropic hormone (ACTH). That prompts your adrenal glands, located on top of your kidneys, to produce cortisol. However, a tumor on your pituitary gland can produce too much ACTH, which may lead to Cushing’s syndrome. Similarly, a tumor on the adrenal gland can directly lead too much cortisol production, thereby causing Cushing’s syndrome. In rare cases, other neuroendocrine tumors located in organs that don’t normally produce ACTH (such as the lungs or pancreas) may secrete ACTH and cause Cushing’s syndrome.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295dee4ce3-b06b-4e6c-a44a-66994e095c12
Diagnosis How Doctors Diagnose Cushing’s Syndrome Diagnosing Cushing’s syndrome can be a challenging process. “First, we need to exclude that the patient is taking any steroids,” says Fleseriu. If your healthcare provider rules out medications that may be raising the risk of Cushing’s syndrome, they will order additional tests. “Testing includes screening, then confirmatory testing as needed,” followed by imaging scans or other tests to locate any tumor, Flesriu added. To screen for endogenous Cushing’s syndrome, your provider may order any of the following tests:e60dc2a1-f33c-4a05-9b50-8e3e8e5976298c5ec6e2-8317-47ad-9598-68fbd370672d 24-hour urine sample to measure your cortisol level Saliva sample to check your cortisol level at night Dexamethasone suppression test to determine your cortisol level after taking a low-dose steroid Abdominal or chest scan to look for ectopic or adrenal tumors MRI scan to find any tumors on your pituitary gland ACTH and dehydroepiandrosterone sulfate blood tests to analyze pituitary and adrenal gland functioning
Questions to Ask Questions to Ask Your Healthcare Provider If you’re concerned about your symptoms, suspect you have Cushing’s syndrome, or already have a diagnosis and need more information, getting answers from your healthcare team can help you stay calm and educated. Consider the following questions to ask your provider at your next appointment: Could one of my medications be causing Cushing’s syndrome? What tests do I need to find the cause of my symptoms? What treatment do you recommend for me? Do I need to see a specialist? Is there anything else I can do to improve my symptoms? What are the chances Cushing’s disease will come back after treatment? How soon can I expect to feel better? Will the condition or the treatment cause long-term effects? Am I at risk of other illnesses? How often do I need to follow up with you?
Cushing’s syndrome is a health condition that can occur when your body is carrying too much cortisol (also known as the stress hormone) over a long period of time. Cushing’s syndrome is rare, and the people diagnosed with it tend to be women between age 30 and 50.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ecd28e7f-9f09-4485-b832-23645f5c9d1f The most common cause of Cushing’s syndrome is taking a glucocorticoid drug (a type of steroid) such as prednisone, but it can also happen when your adrenal glands produce too much cortisol. If you live with Cushing’s syndrome, you may experience symptoms such as unintended weight gain, muscle weakness, and fragile skin that bruises easily.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b7965096-7d9f-49c4-b4cd-a10ca03c319f Cushing’s syndrome can be hard to diagnose. If you suspect that you have symptoms of this condition, seeing a healthcare provider is important. They can order blood, saliva, urine, and imaging tests to help understand what’s going on. Treatment may include lowering your steroid use, surgery, medications, and other therapies.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291286bc10-f782-4923-8701-b73ebaaa05d6
Treatment Treatment for Cushing’s Syndrome If you have exogenous Cushing’s syndrome caused by a glucocorticoid medication, your healthcare provider will gradually reduce your dose. Your provider will try to find the lowest dosage that still helps treat any inflammatory conditions you’re experiencing while also minimizing the effect that the drug is having on your Cushing’s syndrome symptoms. In some cases, they may switch you to a different steroid drug altogether.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296a1a745c-8c1c-4be9-b2a1-723e10f955c6 Generally, you won’t need any other treatments to resolve Cushing’s syndrome in this situation, but it may take you several months to recover, Fleseriu notes. But if you have endogenous Cushing’s syndrome caused by a tumor, surgery to remove the tumor may be recommended in most cases. “Complete resection [removal] of the tumor is the desired goal, but not always possible,” says Fleseriu, especially when it comes to pituitary tumors. “Treatment should be highly individualized.” Surgery is considered the optimal treatment for a pituitary or adrenal tumor causing Cushing’s syndrome. While 90 percent of pituitary tumor surgeries by an experienced surgeon are successful, they aren’t always a cure and may need to be repeated. If an adrenal tumor is causing your symptoms, in most cases it affects only one adrenal gland. Your surgeon will remove the entirety of that adrenal gland. Rarely, both adrenal glands need to be removed. If they are, you’ll need lifelong medication to replace the hormones the adrenal glands make.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291d403c8b-c875-42ab-8b04-554641290191 Other treatments are available, however. Medications can help lower the level of cortisol when surgery isn’t an option or doesn’t cure your symptoms. While medications are not a cure, they can help control cortisol and improve symptoms. If your healthcare provider thinks medications are a good option for you, they may prescribe one of the following drugs:e60dc2a1-f33c-4a05-9b50-8e3e8e59762959c0bd47-1b15-41de-876b-42b80187f513 ketoconazole (Nizoral) levoketoconazole (Recorlev) metyrapone (Metopirone) mifepristone (Korlym) osilodrostat (Isturisa) pasireotide (Signifor)
Lifestyle Habits Lifestyle Habits to Manage Cushing’s Syndrome Making lifestyle changes isn’t an alternative to effective medical or surgical treatment for Cushing’s syndrome. But once you receive proper treatment, “a healthy diet and exercise would be beneficial,” says Fleseriu, since these can improve your overall health and rebuild muscle that may have been lost due to the condition. Swimming, she says, may be a particularly beneficial low-impact exercise. Fleseriu says that it’s also important to make sure you get screening and care for any mental health concerns, like depression or anxiety, as these are common with Cushing’s syndrome. She adds that you and your healthcare provider should watch for health conditions that can coexist with Cushing’s syndrome, such as high blood pressure and osteoporosis. Even after treatment is complete, it’s essential to continue advocating for your own care.